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  • 1.
    Borglin, Gunilla
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Gustafsson, Markus
    Blekinge Institute of Technology, School of Health Science.
    Krona, Hans
    Blekinge Institute of Technology, School of Health Science.
    A theory-based educational intervention targeting nurses’ attitudes and knowledge concerning cancer-related pain management: A study protocol of a quasi-experimental design2011In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, no 233Article in journal (Refereed)
    Abstract [en]

    Background: Pain is one of the most frequent problems among patients diagnosed with cancer. Despite the availability of effective pharmacological treatments, this group of patients often receives less than optimal treatment. Research into nurses’ pain management highlights certain factors, such as lack of knowledge and attitudes and inadequate procedures for systematic pain assessment, as common barriers to effective pain management. However, educational interventions targeting nurses’ pain management have shown promise. As cancer-related pain is also known to have a negative effect on vital aspects of the patient’s life, as well as being commonly associated with problems such as sleep, fatigue, depression and anxiety, further development of knowledge within this area is warranted. Methods/design: A quasi-experimental study design will be used to investigate whether the implementation of guidelines for systematic daily pain assessments following a theory-based educational intervention will result in an improvement in knowledge and attitude among nurses. A further aim is to investigate whether the intervention that targets nurses’ behaviour will improve hospital patients’ perception of pain. Data regarding nurses’ knowledge and attitudes to pain (primary outcome), patient perception regarding pain (secondary outcome), together with socio-demographic variables, will be collected at baseline and at four weeks and 12 weeks following the intervention. Discussion: Nursing care is nowadays acknowledged as an increasingly complicated activity and “nursing complexity is such that it can be seen as the quintessential complex intervention.” To be able to change and improve clinical practice thus requires multiple points of attack appropriate to meet complex challenges. Consequently, we expect the theory-based intervention used in our quasi-experimental study to improve care as well as quality of life for this group of patients and we also envisage that evidence-based guidelines targeting this patient group’s pain will be implemented more widely. Trial Registration Number: ClinicalTrials.gov NCT01313234

  • 2. Genet, Nadine
    et al.
    Boerma, Wienke G. W.
    Kringos, Dionne S.
    Bouman, Ans
    Francke, Anneke L.
    Fagerström, Cecilia
    Melchiorre, Maria Gabriella
    Greco, Cosetta
    Devillé, Walter
    Home care in Europe: a systematic literature review2011In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, no 207Article, review/survey (Refereed)
    Abstract [en]

    Background: Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need, by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade. Methods: A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care ‘policy & regulation’, 'financing', ‘organisation & service delivery’, and ‘clients & informal carers’. Results: Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed. Conclusions: It can be concluded that home care systems appeared to differ not just between but also within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially papers comparing countries. A comprehensive and more complete insight into the state of home care in Europe requires gathering of information using a uniform framework and methodology.

  • 3.
    Gustafsson, Markus
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Borglin, Gunilla
    Blekinge Institute of Technology, School of Health Science.
    Can a theory-based educational intervention change nurses' knowledge and attitudes concerning cancer pain management? a quasi-experimental design2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 328, p. 1-11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Registered Nurses (RNs) play an important role in caring for patients suffering from cancer pain. A lack of knowledge regarding pain management and the RNs' own perception of cancer pain could act as barriers to effective pain management. Educational interventions that target RNs' knowledge and attitudes have proved promising. However, an intervention consisting of evidence-based practice is a multifaceted process and demands behavioural and cognitive changes to sustain the effects of the intervention. Therefore, our study aimed to investigate if a theory-based educational intervention could change RNs' knowledge and attitudes to cancer pain and pain management, both four and 12 weeks after the start of the intervention. METHODS: A quasi-experimental design with non-equivalent control groups was used. The primary outcome was measured using a modified version of the instrument Nurses' Knowledge and Attitudes Survey Regarding Pain (NKAS) at baseline, four weeks and 12 weeks after the start of the intervention to evaluate its persistence. The intervention's educational curriculum was based on the principles of Ajzen's Theory of Planned Behaviour and consisted of interactive learning activities conducted in workshops founded on evidence-based knowledge. The RN's own experiences from cancer pain management were used in the learning process. RESULTS: The theory-based educational intervention aimed at changing RNs knowledge and attitudes regarding cancer pain management measured by primary outcome NKAS resulted in a statistical significant (p<0.05) improvement of total mean score from baseline to four weeks at the intervention ward. CONCLUSIONS: The findings of this study, suggest that a theory-based educational intervention focused at RNs can be effective in changing RN's knowledge and attitudes regarding cancer pain management. However, the high number of dropouts between baseline and four weeks needs to be taken into account when evaluating our findings. Finally, this kind of theory-based educational intervention with interactive learning activities has been sparsely researched and needs to be evaluated further in larger projects.Trial registration: Clinical Trials. Gov: NCT01313234.

  • 4.
    Gustafsson, Markus
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Kristensson, Jimmie
    Blekinge Institute of Technology, School of Health Science.
    Holst, Göran
    Blekinge Institute of Technology, School of Health Science.
    Willman, Ania
    Blekinge Institute of Technology, School of Health Science.
    Bohman, Doris
    Blekinge Institute of Technology, School of Health Science.
    Case managers for older persons with multi-morbidity and their everyday work -- a focused ethnography2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 496Article in journal (Refereed)
    Abstract [en]

    Background Modern-day health systems are complex, making it difficult to assure continuity of care for older persons with multi-morbidity. One way of intervening in a health system that is leading to fragmented care is by utilising Case Management (CM). CM aims to improve co-ordination of healthcare and social services. To better understand and advance the development of CM, there is a need for additional research that provides rich descriptions of CM in practice. This knowledge is important as there could be unknown mechanisms, contextual or interpersonal, that contribute to the success or failure of a CM intervention. Furthermore, the CM intervention in this study is conducted in the context of the Swedish health system, which prior to this intervention was unfamiliar with this kind of coordinative service. The aim of this study was to explore the everyday work undertaken by case managers within a CM intervention, with a focus on their experiences. Methods The study design was qualitative and inductive, utilising a focused ethnographic approach. Data collection consisted of participant observations with field notes as well as a group interview and individual interviews with nine case managers, conducted in 2012/2013. The interviews were recorded, transcribed verbatim and subjected to thematic analysis. Results An overarching theme emerged from the data: Challenging current professional identity, with three sub-themes. The sub-themes were 1) Adjusting to familiar work in an unfamiliar role; 2) Striving to improve the health system through a new role; 3) Trust is vital to advocacy. Conclusions Findings from this study shed some light on the complexity of CM for older persons with multi-morbidity, as seen from the perspective of case managers. The findings illustrate how their everyday work as case managers represents a challenge to their current professional identity. These findings could help to understand and promote the development of CM models aimed at a population of older persons with complex health needs.

  • 5.
    Håkansson, Linda
    et al.
    Center of Excellence for Child Health Services, SWE.
    Derwig, Mariette
    Center of Excellence for Child Health Services, SWE.
    Olander, Ewy
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Parents' experiences of a health dialogue in the child health services: a qualitative study2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 774Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Child Health Services in Sweden is a well-attended health promoting setting, and thereby has an important role in promoting healthy living habits in families with young children. Due to lack of national recommendations for health dialogues, a Child Centred Health Dialogue (CCHD) model was developed and tested in two Swedish municipalities. The aim of this study was to explore parents' experiences of health dialogues based on the CCHD model focusing on food and eating habits during the scheduled child health visit at four years of age. METHODS: A qualitative design with purposeful sampling was used. Twelve individual interviews with parents were conducted and analysed with qualitative content analysis. RESULTS: The analysis resulted in three categories: The health dialogue provides guidance and understanding; Illustrations promote the health dialogue; and Space for children and parents in the health dialogue. In addition, analysis of the latent content resulted in a single theme reflecting the parents' voice on the importance of having a health dialogue on food and eating habits. The health dialogue, promoted by illustrations, provided guidance and understanding, and gave space for children's and parents' involvement. CONCLUSIONS: The results indicate that health dialogues using the CCHD- model create supportive conditions for family members' active participation in the visits, which may strengthen empowerment and health literacy. The study provides knowledge and guidance for further development, evaluation and implementation of the model.

  • 6. Sandberg, Magnus
    et al.
    Ahlström, Gerd
    Axmon, Anna
    Kristensson, Jimmie
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Somatic healthcare utilisation patterns among older people with intellectual disability: an 11-year register study2016In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, no 1, p. 1-13Article in journal (Refereed)
    Abstract [en]

    Background: People with intellectual disabilities (ID) are known to have more diseases and are believed to start aging earlier than the general population. The population of older people with ID is growing, but knowledge about their use of healthcare is limited. This study aimed to explore somatic healthcare utilisation patterns among people with ID living in Sweden, in comparison with the general population from 2002 to 2012. Methods: Participants were a group of people with ID (n = 7936) aged 55 years and older in 2012, and an equal-sized, birth year and sex matched, general population sample (n = 7936). Participants were divided into age groups of 5-year intervals. Data regarding in- and outpatient care were collected from the Swedish National Patient Register. Results: In the younger age groups, the ID group had higher healthcare utilisation compared with the general population sample, with higher risks for planned and unplanned somatic in- and outpatient care, particularly for unplanned inpatient registrations. Decreasing patterns were seen with age; with lower risks in the ID group for the oldest age groups. This was most evident in planned somatic in- and outpatient care. In those with at least one registration, the ID group had a longer unplanned length of stay in the younger age groups, but fewer planned visits to physicians in somatic outpatient care compared with the control group. Conclusions: Compared with the general population, people with ID show higher healthcare utilisation in younger age groups. Healthcare utilisation decreases with age, and in old age, fewer people with ID use healthcare compared with the general population. The barriers to accessing planned healthcare for older people with ID need more investigation. © 2016 The Author(s).

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